Information Collection

Public Health and Medical Emergency Planners/Key Informants - Questionnaire

IC 228842 under ICR 201803-0920-018 · OMB 0920-1221.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1221 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Public Health and Medical Emergency Planners/Key Informants - Questionnaire	Form and Instruction
Key Informant/Stakeholder Questionnaire AttC-Questionnaire.docx	Form and Instruction

IC Title:

Public Health and Medical Emergency Planners/Key Informants - Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Key Informant/Stakeholder Questionnaire	AttC-Questionnaire.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.